TEA is effective and justified preventive method in patients with high risk of postoperative pancreatitis. In low risk patients use of indomethacin per rectum is preferred compared with TEA due to its invasiveness.

To evaluate the effectiveness of thoracic epidural analgesia (TEA) for prevention of post-ERCP pancreatitis (PEP). Materials and methods. Between 2015 and 2019, a randomized study of the results of endoscopic treatment in 491 patients was conducted. The first group of patients (N=247) received thoracic epidural analgesia during ERCP procedures, the patients of the second group (N=244) received a narcotic analgesic. Results. In the first (TEA) group there were no cases of pancreatic necrosis and fatal outcome, in the second (control) group in 7 (2.9%) patients were diagnosed with this adverse event, of which 3 (1.2%) patients died. A statistically significant reduction in the incidence of PEP was found due to the use of epidural analgesia in all age categories (p = 0.0004-0.0232), in women (p = 0.0000) and men (p = 0.0057), patients with jaundice (p = 0.0000), with sphincter of Oddi dysfunction (p = 0.0000), with common bile duct stones (p = 0.0004), with tumor (p = 0.0010), after biliary sphincterotomy (p = 0.0000), biliary-stone extraction (p = 0.0013), nasobiliary drainage (p = 0.0016). The study has proved the effectiveness of thoracic epidural analgesia in patients with high risk of post-ERCP pancreatitis (p = 0.0000). Conclusion. The use of thoracic epidural analgesia during therapeutic ERCP procedures is an effective method of preventing post-ERCP pancreatitis. K E Y w O R D S-therapeutic ERCP, prevention of post-ERCP pancreatitis, thoracic epidural analgesia.

Goal. Optimizing a differentiated approach to choice the method of internal biliary excretion for improvement the results of patients treatment with unresectable tumors of the hepatopancreatobiliary zone complicated by syndrome of obstructive jaundice. Material and methods. The results of surgical, endoscopic transpapillary, percutaneous transhepatic endobiliary interventions and their terminal application in 431 patients with inoperable tumors of the hepatopancreatobiliary zone complicated by obstructive jaundice syndrome are analyzed. Results. Were managed to perform palliative internal choleresis to all patients. Postoperative complications were noted in 9% of cases. Mortality rate was 7.66%. Long-term results were studied in 74.5% of patients in terms from 3 to 30 months. Conclusion. The proposed therapeutic algorithm determines the most effective use of surgical and minimally invasive variants of internal choleresis in patients with unresectable tumors of the hepatopancreatobiliary zone and allows avoiding the long-term complications characterised for bilioduodenal stenting.

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